Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Authors: Rajnish Mehrotra, Sara N. Davison, Ken Farrington, Jennifer E. Flythe, Marjorie Foo, Magdalena Madero, Rachael L. Morton, Yusuke Tsukamoto, Mark L. Unruh, Michael Cheung, Michel Jadoul, Wolfgang C. Winkelmayer, Edwina A. Brown, Peace Bagasha, Joanne M. Bargman, Sunita Bavanandan, Hannah Beckwith, Paul N. Bennett, Clara Bohm, Frank Brennan, James O. Burton, Kerri L. Cavanaugh, Joseph Chilcot, Peter Choi, Daniel Cukor, Laura M. Dember, Jie Dong, Dawn Edwards, Kevin F. Erickson, Ana Figueiredo, Fredric O. Finkelstein, Masafumi Fukagawa, Michael Germain, Franklin B. Guillano, Helen Hurst, Kunitoshi Iseki, Meg J. Jardine, Allison Jauré, Vivekanand Jha, Manisha Jhamb, Talerngsak Kanjanabuch, Edgar Lerma, Philip Kam-Tao Li, Adrian Liew, Jolanta Małyszko, Thyago Proenca de Moraes, Olivier Moranne, Marques Shek Nam Ng, Marlies Ostermann, Jeffrey Perl, Jayne Pigford, Wolfgang Pommer, Michelle M. Richardson, Matthew B. Rivara, Glenda V. Roberts, Pantelis Sarafidis, Rukshana Shroff, Maria Fernanda Slon Roblero, Brendan Smyth, Henning Søndergaard, Sabine N. Van Der Veer, Joseph A. Vassalotti, Marc Vervloet, Lloyd Vincent, Rachael Walker, Madeleine Warren, Betty Ann Wasylynuk, Melissa West, Caroline Wilkie
Journal: Kidney International (2023)

Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality. Routine symptom assessment is not universal or standardized in dialysis care. Even when symptoms are identified, treatment options are limited and are initiated infrequently, in part because of a paucity of evidence in the dialysis population and the complexities of medication interactions in kidney failure. In May of 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference-Symptom-Based Complications in Dialysis-to identify the optimal means for diagnosing and managing symptom-based complications in patients undergoing maintenance dialysis. Participants included patients, physicians, behavioral therapists, nurses, pharmacists, and clinical researchers. They outlined foundational principles and consensus points related to identifying and addressing symptoms experienced by patients undergoing dialysis and described gaps in the knowledge base and priorities for research. Healthcare delivery and education systems have a responsibility to provide individualized symptom assessment and management. Nephrology teams should take the lead in symptom management, although this does not necessarily mean taking ownership of all aspects of care. Even when options for clinical response are limited, clinicians should focus on acknowledging, prioritizing, and managing symptoms that are most important to individual patients. A recognized factor in the initiation and implementation of improvements in symptom assessment and management is that they will be based on locally existing needs and resources.